| NPI | 1841645447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60997044) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 0902000X) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2020-09-08 |